Individual
DR. DANIELLE L. DIVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSY. D
Contact information
Practice address
7564 WOODBURY PIKE, ROARING SPRING, PA 16673
(814) 729-7316
(814) 729-7538
Mailing address
7564 WOODBURY PIKE (PO BOX 155), ROARING SPRING, PA 16673
(814) 729-7316
(814) 729-7538
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
PS016634
PA
103TC0700X
Clinical Psychologist
Primary
PS016634
PA
103TC0700X
Clinical Psychologist
PS016634PA
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000285381
UNISON
PA
01
—
002106964
HIGHMARK BLUE CROSS BLUE SHIELD
PA
05
—
1007708200003
—
PA
05
—
102312888
—
PA
05
—
1023128880002
—
PA
05
—
1023128880003
—
PA
05
—
1023128880004
—
PA
01
—
164856RGD
MEDICARE
PA
Enumeration date
01/29/2009
Last updated
10/23/2024
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